This prospective study included 1,044 pediatric patients with MP infection diagnosed serologically with MP IgM at one medical center from January 2006 to December 2012. Eighty of these patients had elevated levels of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT), each greater than 50 IU/L, without any other specific liver disorder and were compared with the 964 children without liver disorders.
In total, 7.7% of patients with MP infection had a diagnosis of hepatitis, especially in fall and winter. The ratio of male to female patients was 1.7:1, and the mean age of the patients was 5 years and 5 months. The most common symptoms were cough, fever, and sputum. Anorexia was the most common gastrointestinal symptom, followed by nausea/vomiting, diarrhea, and abdominal pain. Mean levels of AST and ALT were 100.65 IU/L and 118.73 IU/L, respectively. Serum AST/ALT level was normalized within 7.5 days on average without complications. The mean duration of hospitalization (11.3 days) was longer for children with hepatitis than for those without hepatitis (
MP-associated hepatitis is not uncommon and has a relatively good prognosis. Therefore, clinicians should be concerned about liver involvement in MP infection but avoid further unnecessary evaluation of hepatitis associated with MP.
We prospectively examined the clinical features of hepatitis complicated with
The research was conducted prospectively between January 2006 and December 2012 for identification of the age and gender distribution, seasonal distribution, clinical manifestations, laboratory and radiological findings, and treatment outcomes in
The results were analyzed using MedCalc ver. 13.3.0 (MedCalc Software, Mariakerke, Belgium) and were expressed as mean±standard deviation, standard error or as percentage. Independent Student
The incidence of hepatitis complicated with
Age ranged from 10 months to 16 years, with a mean of 5.51±3.32 years and a median of five years and a half. The male-to-female ratio was 1.7 to 1 (
Among 1,044
Among children with
The most common finding of physical examination was coarse breathing sound (56 cases, 70%), followed by rale (40 cases, 50%), pharyngeal injection (38 cases, 47.5%), decreased breathing sound (19 cases, 23.8%), and palatine tonsillar hypertrophy (17 cases, 21.3%). The nonrespiratory sign most frequently found by examinations was rash (4 cases, 5%), followed by hepatomegaly (3 cases, 3.8%), and cervical lymph node enlargement (2 cases, 2.5%) (
Eleven cases (13.8%) had hemoglobin of less than 11 g/dL, and the most common level of peripheral blood white blood cell was 5,000-9,999/mm3 (42 cases, 52.5%), followed by 10,000/mm3 or more (29 cases, 36.3%) and less than 5,000/mm3 (9 cases, 11.2%). The results of blood smear showed neutrophilia (>70%) in 21 cases (26.3%), and eosinophilia (>3%) in 32 cases (40.0%). Twelve cases (15.0%) had platelet increased to 450,000/mm3 or more and four cases (5.0%) had it decreased to less than 150,000/mm3 (
The average erythrocyte sedimentation rate (ESR) was 25.61±22.22 mm/hr and was elevated by 10 mm/hr or higher in 61 cases (76.3%). C-reactive protein (CRP) was 5.39±5.67 mg/dL on average with a maximum of 22.02 mg/dL and was elevated to 0.7 mg/dL or more in 64 cases (80.0%) (
AST was 100.65±20.34 IU/L on average with a maximum of 1,330 IU/L, and ALT was 118.73±19.43 IU/L on average with a maximum of 1,171 IU/L at day of admission. The average level of bilirubin was 0.39±0.16 mg/dL, with only one case of hyperbilirubinemia (>1.2 mg/dL). Total protein and albumin were 6.73±0.74 g/dL and 3.96±0.57 g/dL on average, respectively, and the latter decreased to less than 3.5 g/dL in 21 cases (26.3%) with the minimum measured value of 2.9 g/dL (
All children with
All children with
Our study has been done prospectively using IgM antibodies for diagnosis of
It is believed that formation of
The other hypothesis is that
While some researchers
We observed that
It has also been reported that
Regarding the clinical features of
Regarding hematological findings, Smith et al.
The principal type of liver disorder is an elevated AST level, and jaundice is rarely found
While we did not perform liver biopsy for any of the patients, one case report in which liver biopsy was performed
While the findings from chest radiology for
This study has a few limitations: Since elevated level of IgM will decay slowly through up to 6 months, it is not certain if the reaction is from current infection or from a primary abnormality. Also poor sensitivity of IgM in the very early phase of the disease could have resulted in failure to diagnose some children with
In conclusion, hepatitis complicated with
This article's abstract was chosen and presented as Oral Abstract Communications Session in ESPGHAN 2014.
Clinical feature | No. of patients (%) |
---|---|
Cough | 76 (95.0) |
Fever | 69 (86.3) |
Sputum | 61 (76.3) |
Anorexia | 44 (55.0) |
Rhinorrhea | 42 (52.5) |
Nausea or vomiting | 24 (30.0) |
Diarrhea | 13 (16.3) |
Abdominal pain | 7 (8.8) |
Dyspnea | 5 (6.3) |
Headache | 3 (3.8) |
Seizure | 1 (1.3) |
Flank pain | 1 (1.3) |
Physical finding | No. of patients (%) |
---|---|
Coarse breathing sound | 56 (70.0) |
Rale | 40 (50.0) |
Pharyngeal injection | 38 (47.5) |
Decreased breathing sound | 19 (23.8) |
Palatine tonsillar hypertrophy | 17 (21.3) |
Wheezing | 7 (8.8) |
Chest retraction | 6 (7.5) |
Rash | 4 (5.0) |
Hepatomegaly | 3 (3.8) |
Cervical lymphadenopathy | 2 (2.5) |
Splenomegaly | 1 (1.3) |
Conjunctival injection | 1 (1.3) |
Systolic murmur | 1 (1.3) |
Hematologic finding | Value |
---|---|
Hemoglobin (g/dL) | |
<11.0 | 11 (13.8) |
≥11.0 | 69 (86.2) |
Mean±SD | 11.89±1.29 |
WBC count (/mm3) | |
<5,000 | 9 (11.2) |
5,000-9,999 | 42 (52.5) |
10,000-14,999 | 15 (18.8) |
≥15,000 | 14 (17.5) |
Mean±SD | 10,041.35±5,153.72 |
Neutrophil (%) | |
<70.0 | 59 (73.7) |
≥70.0 | 21 (26.3) |
Mean±SD | 61.07±17.26 |
Eosinophil (%) | |
<3.0 | 48 (60.0) |
≥3.0 | 32 (40.0) |
Mean±SD | 3.00±3.42 |
Platelet count (103/mm3) | |
<150 | 4 (5.0) |
150-449 | 64 (80.0) |
≥450 | 12 (15.0) |
Mean±SD | 306.16±120.69 |
Values are presented as number (%) unless otherwise indicated.
WBC, white blood cell; SD, standard deviation.
Acute phase reactant | Value |
---|---|
ESR (mm/hr) | |
<10.0 | 19 (23.8) |
≥10.0 | 61 (76.2) |
Mean±SD | 25.61±22.22 |
CRP (mg/dL) | |
<0.7 | 16 (20.0) |
≥0.7 | 64 (80.0) |
Mean±SD | 5.39±5.67 |
Values are presented as number (%) unless otherwise indicated.
ESR, erythrocyte sedimentation rate; CRP, C-reactive protein.
Liver function test | Value |
---|---|
AST (IU/L) | |
50-99 | 36 (45.0) |
100-499 | 40 (50.0) |
500-999 | 3 (3.7) |
≥1,000 | 1 (1.3) |
Mean±SE | 100.65±20.34 |
ALT (IU/L) | |
50-99 | 42 (52.5) |
100-499 | 35 (43.7) |
500-999 | 2 (2.5) |
≥1,000 | 1 (1.3) |
Mean±SE | 118.73±19.43 |
Total bilirubin (mg/dL) | |
<1.2 | 79 (98.7) |
≥1.2 | 1 (1.3) |
Mean±SD | 0.39±0.16 |
Protein (g/dL) | |
<6.0 | 10 (12.5) |
≥6.0 | 70 (87.5) |
Mean±SD | 6.73±0.74 |
Albumin (g/dL) | |
<3.5 | 21 (26.3) |
≥3.5 | 59 (73.7) |
Mean±SD | 3.96±0.57 |
Values are presented as number (%) unless otherwise indicated.
AST, aspartate aminotransferase; ALT, alanine aminotransferase; SE, standard error; SD, standard deviation.
Type | No. of patients (%) |
---|---|
Lobar or Lobular pneumonia | 63 (78.7) |
Bronchopneumonia | 13 (16.3) |
Interstitial pneumonia | 4 (5.0) |
Site | No. of patients (%) |
---|---|
Pneumonic consolidation (n=63) | |
Unilateral | 50 (82.0) |
Right lung | 27 (44.3) |
Left lung | 23 (37.7) |
Bilateral | 13 (21.3) |
Right upper lobe | 18 (29.5) |
Right middle lobe | 13 (21.3) |
Right lower lobe | 20 (32.8) |
Parahilum | 18 (29.5) |
Left upper lobe | 10 (16.4) |
Left lower lobe | 24 (39.3) |
Pleural effusion (n=11) | |
Unilateral | 11 (100) |
Right lung | 6 (54.5) |
Left lung | 5 (45.5) |
Bilateral | 0 (0) |
Duration (day) | Group A (n=80) | Group B (n=964) | |
---|---|---|---|
1-7 | 20 (25.0) | 707 (73.3) | |
8-14 | 45 (56.2) | 225 (23.3) | |
15-21 | 8 (10.0) | 20 (2.1) | |
22-28 | 5 (6.3) | 4 (0.4) | |
≥29 | 2 (2.5) | 8 (0.8) | |
Mean±SD | 11.33±5.90 | 6.90±3.68 | <0.05 |
Values are presented as number (%) unless otherwise indicated.
Group A, patients with
Duration (day) | Value |
---|---|
1-7 | 44 (55.0) |
8-14 | 30 (37.5) |
15-21 | 4 (5.0) |
22-28 | 2 (2.5) |
Mean±SD | 7.51±4.57 |
Values are presented as number (%) unless otherwise indicated.